Common Forms

Download common forms here

Below you can download and view our common forms. If you are scheduling a transport, your insurer may require you (or your patient) to have a Physicians Certification Statement completed and signed by the appropriate person. Please check with your insurance to see what they require. These forms are for public use, we hope they help you with our service.

Note- All authorizations and requests are subject to approval by the HIPAA Privacy and Compliance officer. Please note, if you are a power of attorney for a patient requesting records, you will need to provide a copy of the power of attorney form in order to obtain records. Patients may be asked to provide ID proving their identity. Please contact HIPAA Officer Nathan Harig with any questions.